womb & sacral massage

booking form

thank you for choosing nama mama.

please fill in this booking form so that i have some details before we meet in order to make the most of our time & tailor the treatment to you.

should you have any questions about the treatment, please feel free to contact me at any time, i’m more than happy to have a chat.

i look forward to meeting you soon! best wishes, emma xx

womb massage details

your treatment

upon receipt of your booking form i will send a confirmation email to confirm the date for your treatment with payment link - please note your booking is not confirmed until payment is received.

your contact details

all information is kept securely & confidentially, in line with current gdpr requirements. i will never share your details with a third party.

name

First Name

Last Name

your pronouns

if you'd like to share, just so i know how you like to be addressed. your answer to these questions is always treated in confidence

phone

date of birth

YYYY

home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

is this the address where the treatment will take place?

if no, please provide location address

tell me about you

the information you provide will help me to understand a little bit about you, your pregnancy or birth experience & where you are in your life right now to incorporate that into the session

about you

if you'd like to share your age, what you do, what are your passions or anything to help me get to know you a little (no pressure!)

please share a little about what draws you to receive this womb massage

if you have any specific physical or wellness issues there is space for that below

how would you describe your current relationship with your womb/menstrual cycle?

how long is your menstrual cycle?

this is the time of

when was your last period?

do you have any physical concerns, contraindications or allergies?

this womb massage should not be carried out if you are pregnant or may be pregnant, it is also not advisable on the lower abdomen if you are menstruating. if you are trying to conceive, the massage should not be received during ovulation. i will be using aromatherapy massage oils if there are any allergy concerns, please let me know.

if you had a caesarean birth or had an episiotomy/tear during birth, please confirm you will be 6/8weeks post birth when the closing takes place?

there should be a 6/8 week period for the necessary healing to take place within the muscle layer before receiving a massage after caesarean birth or episiotomy/vaginal tearing.

terms & conditions

a booking does not constitute the creation of a contract and nama mama hypnobirthing reserves the right to decline to process a booking for any reason whatsoever. if the booking is not able to be fulfilled nama mama will refund all monies. vat is not applicable. payment: please make payment in full upon booking. booking date: the date of booking the session has been agreed upon although allowing for flexibility when booking whilst pregnant for your birthing time to change! please let me know once your baby is born if you need to make any changes to the booking date & we will reconfirm. cancellation: if you wish to cancel the ceremony for any reason please allow 3 working days prior to booking date to inform me. a full refund will be issued. nama mama reserves the right to amend or cancel any published prices. in the rare event that nama mama needs to cancel a booking, a full refund will be given. intellectual property: any recordings or written material included as part of this session are the sole property of the nama mama and may not be used or copied other than for the personal use of the participant without obtaining prior written permission from nama mama. data protection: the participant also agrees that nama mama shall hold your details on file and on computer and, in accordance with the data protection act 1998. you are able to view your individual file by giving not less than seven days written notice.

i have read & agree to the terms & conditions

how did you hear about nama mama?

womb & sacral massage

booking form

womb wellness sessions & alternative therapies to support menstruation, fertility, pregnancy, birth, postpartum & menopause

surrey, sussex & online